艾滋病合并马尔尼菲篮状菌血流感染的临床流行病学分析  

Clinical Epidemiological Analysis of AIDS Complicated with Penicillium Marneffei Bloodstream Infection

作　　者：冯能能 赵传宇 马跃 王舒 张海霞 谢荣慧 FENG Nengneng;ZHAO Chuanyu;MA Yue;WANG Shu;ZHANG Haixia;XIE Ronghui(School of Public Health,Dali University,671000;Yunnan Provincial Infectious Disease Hospital,Kunming,650300)

机构地区：[1]大理大学,云南大理671000 [2]云南省传染病医院,云南安宁650300

出　　处：《智慧健康》2025年第4期30-33,41,共5页Smart Healthcare

基　　金：云南省传染病临床医学中心项目《HIV感染新生儿清除病毒方案研究》(项目编号:202102AA310005)。

摘　　要：目的分析艾滋病合并马尔尼菲篮状菌血流感染患者的临床流行病学特征,探究影响预后不良的危险因素,为判断预后和控制感染提供参考。方法回顾性分析2017—2023年云南省传染病医院收治的艾滋病合并马尔尼菲篮状菌血流感染患者119例为研究对象,收集并分析其临床特征和实验室数据,运用多因素Logistic回归分析法,分析影响其预后不良的危险因素。结果纳入的119例患者中,预后良好组98人(82.35%),预后不良组21人(17.65%)。流行病学特征以男性、汉族人口最多,且大多数是已婚患者;临床特征多为发热、咳嗽、皮疹;预后不良组血小板(PLT)、白蛋白(ALB)、血红蛋白(HB)、降钙素原(PCT)、总蛋白(TP)、CD4的计数低于预后良好组。二元Logistic回归分析结果显示,PLT[(OR=1.012),95%CI(1.002,1.022)]和未进行抗逆转录病毒治疗(ART)[(OR=7.881),95%CI(2.705,22.956)]是影响艾滋病合并马尔尼菲篮状菌血流感染患者预后不良的独立危险因素,绘制ROC曲线发现,PLT对诊断艾滋病合并马尔尼菲篮状菌血流感染预后的预测价值较高(AUC=0.705),截断值为59.50×10^(9)/L,即当PLT计数低于59.50×10^(9)/L时,发生预后不良的可能性增加,应结合临床进行评估。结论艾滋病合并马尔尼菲篮状菌血流感染患者出现发热、咳嗽、皮疹等症状,尤其是未进行ART治疗和PLT计数低下时,要注意预后不良的情况发生。Objective To explore the epidemiological and clinical characteristics of AIDS patients with Marneffei basiliformis bloodstream infection,analyze the risk factors affecting the poor prognosis,and provide reference for prognosis and infection control.Methods A retrospective analysis was performed on patients with AIDS complicated by T.marneffei bloodstream infection admitted to Yunnan Provincial Infectious Disease Hospital from 2017 to 2023.Clinical characteristics and laboratorydata were collected and analyzed.Univariate and multivariate logistic regression were used to analyze the risk factors affecting poor prognosis.Results A total of 119 patients were included,98(82.35%)in the good prognosis group and 21(17.65%)in the poor prognosis group.The majority of the population were male and Han,and most of the patients were married.The clinical features were fever,cough and rash.PLT,ALB,HB,PCT,TP and CD4 counts in the poor prognosis group were lower than those in the good prognosis group.Binary logistic regression analysis showed that PLT[(OR=1.012),95%CI(1.002,1.022)]and ART[(OR=7.881),95%CI(2.705,22.956)]were independent risk factors for poor prognosis in patients with AIDS complicated by T.marneffei bloodstream infection.ROC curve showed that PLT had a high predictive value for the prognosis of AIDS complicated by T.marneffei bloodstream infection(AUC=0.705),with a cutoff value of 59.50×10^(9)/L.That is,when the platelet count was lower than 59.50×10^(9)/L,the possibility of poor prognosis increased,and it should be evaluated in combination with clinical practice.Conclusion For patients with AIDS and T.marneffei bloodstream infection who have symptoms such as fever,cough and rash,especially when they are not receiving ART treatment and have low platelet counts,attention should be paid to the possibility of a poor prognosis.

关 键 词：艾滋病 血流感染 马尔尼菲篮状菌 临床流行病学 预后 

分 类 号：R512.91[医药卫生—内科学]